Clinically relevant interpretation of solid phase assays for HLA antibody

Maria P. Bettinotti, Andrea A. Zachary, Mary S. Leffell

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of review Accurate and timely detection and characterization of human leukocyte antigen (HLA) antibodies are critical for pre-transplant and post-transplant immunological risk assessment. Solid phase immunoassays have provided increased sensitivity and specificity, but test interpretation is not always straightforward. This review will discuss the result interpretation considering technical limitations; assessment of relative antibody strength; and the integration of data for risk stratification from complementary testing and the patient's immunological history. Recent findings Laboratory and clinical studies have provided insight into causes of test failures-false positive reactions because of antibodies to denatured HLA antigens and false negative reactions resulting from test interference and/or loss of native epitopes. Test modifications permit detection of complement-binding antibodies and determination of the IgG subclasses. The high degree of specificity of single antigen solid phase immunoassays has revealed the complexity and clinical relevance of antibodies to HLA-C, HLA-DQ, and HLA-DP antigens. Determination of antibody specificity for HLA epitopes enables identification of incompatible antigens not included in test kits. Summary Detection and characterization of HLA antibodies with solid phase immunoassays has led to increased understanding of the role of those antibodies in graft rejection, improved treatment of antibody-mediated rejection, and increased opportunities for transplantation. However, realization of these benefits requires careful and accurate interpretation of test results.

Original languageEnglish (US)
Pages (from-to)453-458
Number of pages6
JournalCurrent opinion in organ transplantation
Volume21
Issue number4
DOIs
StatePublished - Aug 1 2016

Keywords

  • Antibody-mediated rejection
  • HLA epitopes
  • HLA-specific antibodies
  • solid phase immunoassays

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation

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